SCOTT ANTHONY BLACKBURN NP NPI 1003554494

NPI Information

NPI: 1003554494
Provider Name: SCOTT ANTHONY BLACKBURN, NP
Classification: Nurse Practitioner - 363LP2300X
Entity Type: Individual

Specialization: Primary Care

PECOS Registration: Yes

Address:
15150 FORT ST
SOUTHGATE, MI
ZIP 48195
Phone: (734) 282-4800
Get Directions

Scott Anthony Blackburn, NP is a primary care nurse practitioner in Southgate, MI with 2 years of experience. Scott Anthony Blackburn, NP NPI is 1003554494. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15150 FORT ST
SOUTHGATE, MI
ZIP 48195-302
Phone: (734) 282-4800
Fax: (734) 282-9302

The NPI 1003554494 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/25/2022 and was last updated on 4/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care	4704326782	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	4704326782	OTHER	MICHIGAN	STATE LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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